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Advances in cardiac pacing: beyond the transvenous right ventricular apical lead.
MedLine Citation:
PMID:  20553288     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
While for decades right ventricular (RV) apical pacing has been the standard of care for patients requiring pacemaker or defibrillator lead placement, investigators have sought alternatives to achieve more physiologic electrical activation of the heart and reduce long-term pathologic effects of nonphysiologic apical pacing. These investigations have included attempts at identifying superior pacing sites within the right atrium and RV and development of new leads to enhance specificity of sensing and capture. This review focuses on recent advances in alternative sites for pacing and developments in novel pacing technology ranging from intramyocardial electrodes to leadless pacemakers. First, there have been several studies demonstrating potential benefits of site-specific pacing, including His bundle pacing and RV outflow tract pacing in potentially attenuating electromechanical dyssynchrony and long-term functional decline seen with RV apical pacing. Available options for lead placement have been enhanced by development of intramyocardial electrodes that may significantly reduce far-field oversensing and nonchamber specific capture. With development of intramyocardial electrodes, the potential for atrioventricular septal pacing has recently been described, making synchronous activation of both ventricles with a one-lead system possible without crossing the tricuspid valve and offering an alternative to modern cardiac resynchronization therapy (CRT). Finally, recent advances in leadless pacemaker systems using ultrasound or magnetic fields are briefly discussed. The results of these studies suggest that there may be options to the RV apex, made possible by novel lead and pacemaker technology. These advances can potentially aid in reducing long-term negative effects of chronic pacemaker therapy.
Authors:
Suraj Kapa; Charles J Bruce; Paul A Friedman; Samuel J Asirvatham
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Cardiovascular therapeutics     Volume:  28     ISSN:  1755-5922     ISO Abbreviation:  Cardiovasc Ther     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-05     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101319630     Medline TA:  Cardiovasc Ther     Country:  England    
Other Details:
Languages:  eng     Pagination:  369-79     Citation Subset:  IM    
Copyright Information:
© 2010 Blackwell Publishing Ltd.
Affiliation:
Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
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